Clinical features, antifungal susceptibility, and outcome of Candida guilliermondii fungemia: An experience in a tertiary hospital in mid-Taiwan.

BACKGROUNDS: Candida guilliermondii is rarely isolated from clinical specimen. C. guilliermondii fungemia is seldom reported in the literature. The aims of this study were to report the clinical features, antifungal susceptibility, and outcomes of patients with C. guilliermondii fungemia. METHODS: From 2003 to 2015, we retrospectively analyzed the clinical and laboratory data of patients with C. guilliermondii fungemia in a tertiary hospital in mid-Taiwan. We performed a multivariable logistic regression analysis to identify the risk factors of mortality. The Sensititre YeastOne microtiter panel assessed the susceptibility of antifungal agents. RESULTS: In this study, we identified 36 patients with C. guilliermondii fungemia. The median age of patients was 50.5 years (range, 17 days to 96 year) and 20 cases (56%) were male. The incidence of C. guilliermondii fungemia was 0.05 per 1000 admissions. Malignancy was the most common co-morbidity, and 25 (69%) patients had central venous catheter in place. Thirty-day overall mortality was 16.7%. In multivariate logistical regression analysis, catheter retention was an independent risk factor of mortality. According to epidemiological cutoff values, most clinical isolates (21/22, 95.5%) belonged to the wild-type MIC distributions for amphotericin B and flucytosine; however, the isolates were less susceptible to fluconazole (68%) and echinocandins (77-91%). CONCLUSION: Despite the lower mortality rate associated with C. guilliermondii fungemia, the removal of a central venous catheter remained an independent factor influencing the outcome of patients. The clinical significance of less susceptibility of C. guilliermondii to triazoles and echinocandins remains to be elucidated.

Spinal tuberculosis in non-HIV-infected patients: 10 year experience of a medical center in central Taiwan.

BACKGROUND/PURPOSE: Tuberculosis (TB) is an endemic disease in Taiwan and it usually affects the lung. Spinal TB accounts for 1-3% of all TB infections. The purpose of this study was to investigate the clinical manifestations, management, outcomes and drug susceptibility of Mycobacterium tuberculosis in non-HIV-infected patients with spinal TB. METHODS: From January 1998 to December 2007, we retrospectively reviewed the medical charts of adult patients with a diagnosis of spinal TB. Only those with positive culture results and/or characteristic pathologic findings were enrolled. Demographic data, clinical manifestations and susceptibility to anti-TB drugs were reviewed and analyzed. RESULTS: During the study period, 38 patients (23 men, 15 women) with spinal TB were identified and the mean age was 68 years. The median duration of symptoms was 60 days (range, 3-720 days). Amongst the 38 patients, back pain (100%) was the most common clinical symptom, followed by weakness (53%) and numbness (26%). The lumbar spine (15 patients, 39%) was the most commonly involved site, followed by the thoracic spine (14 patients, 37%). Concomitant pulmonary TB was found in 12 patients (32%). Three patients (8%) had concurrent bacterial or fungal infections. Almost all of the patients (35 patients, 92%) were successfully treated with surgery and anti-TB medications. The erythrocyte sedimentation rate was followed up in 16 patients before and after therapy and a significant decline was observed after treatment (p = 0.004). No mortality was related to spinal TB. CONCLUSION: Insidious clinical course and ambiguous manifestations of spinal TB often delay and hinder the accuracy of diagnosis of spinal TB. In addition to pyogenic osteomyelitis, spinal TB should be included in the differential diagnosis especially in elderly patients with chronic back pain accompanied by elevated erythrocyte sedimentation rate, and those living in the TB endemic area.